Eyes Flashcards
(23 cards)
Conjunctivitis
A: Bacterial, viral, chlamydia, allergic, toxic/drops.
S: Red eye, purulent or watery discharge, itchy, gritty sticky.
D: If severe/recurrent then conjunctival swab.
T: Topical antibiotics if bacterial.
Subconjunictival haemorrhage
A: Blood under conjunctiva from trauma, valsalva, HTN, bleeding disorders, anitocoagulants, idiopathic or orbital mass.
S: Blood under conjunctiva, red eye.
D: If other orbital signs, CT head. If recurrent, check for coagulopathy.
T: Nil.
Episcleritis
A: Usually idiopathic, common in young adults.
S: inflammation, engorged vessels, painful red eye.
D: -
T: Usually self-limiting, topical steroids for comfort.
Scleritis
A: Often associated with systemic connective tissue disease, rheumatoid arthritis.
S: inflammation, engorged vessels, severe eye pain, red eye, may have reduced vision.
D: -
T: Oral NSAIDs/steroids.
Keratitis
A: Corneal inflammation: viral (herpes), bacterial, fungal, acanthamoeba.
S: Ulcer/epithelial defect (check for dendrite in herpes simplex infection), corneal opacity, discharge, hypopynon, painful red eye, maybe a skin rash (with herpes zoster).
D: corneal scrape
T: Topical antibiotics/anti-fungals/antivirals
Acute angle closure glaucoma
A: Angle closure due between iris and trabecular meshwork which impairs aqueous outflow.
Often due to pupil block.
S: Raised IOP, closed angle, conjuncitval infection, fixed mid-dilated pupil, hazy cornea, painful red eye, blurred vision, nausea, vomiting, headache.
D: Check IOP, gonioscopy
T: Urgent opthalmology referral, laser iridotomy.
uveitis (acute iritis)
A: Inflammation of uveal tract (iris, cilliary body, choroid). Often idiopathic, can be associated with systemic disease, infection or trauma.
S: Keratitic precipitates, floaters, blurred vision, conjuncitval infection, painful red photophobic eye.
Signs include keratitic precipitates, dilated ciliary vessels and cells in anterior chamber
Anterior = pain/redness and photophobia, but may also get floaters, blurred vision. (most common)
Intermediate = floaters and blurred vision
Posterior = vision problems
D: -
T: Topical steroids and mydriatics.
Central retinal artery occlusion
A: Occlusion leads to hypoxia of retina. Usually atherosclerotic but can be embolic or inflammatory.
S: White, swollen retina, cherry red spots at macula, RAPD. Causes sudden, unilateral, painless vision loss.
D: -
T: Occular massage, reduce IOP, rule out GCA.
Central retinal vein occlusion
A: Diabetes, HTN, hypercholesterolaemia, glaucoma.
S: Retinal haemorrhages, tortuous veins, optic disc swelling, cotton wool spots.
Painless loss of vision in one eye.
D: B scan if no retinal view.
T: Reduce IOP, photocoagulation if neurovascularisation.
Giant cell (temporal) arteritis
A: Arterial inflammation and ischaemia of optic nerve head.
S: RAPD, swollen pale disc, thick, tender, non-pulsatile temporal artery.
Sudden vision loss, scalp tenderness, headache, jaw claudication.
D: Temporal artery biopsy.
T: High dose steroids.
Vitrous haemorrhage
A: Diabetic retinopathy, posterior vitreous detachment, retinal tear/detachment, retinal vein occlusion, trauma, cancer.
S: Blood within vitreous, obscured fundal view, sudden, painless loss of vision.
D: B scan if no retinal view.
T: May require surgical removal of blood (vitrectomy)
Posterior vitreous dettachment
A: Ageing process, may occur earlier in myopia, trauma, inflammation, connective tissue disease.
S: Weiss ring, visible posterior hyaloid face. Flashes of light, floaters.
D: -
T: Monitor and warn of symptoms of retinal detachment (a complication)
Retinal detachment
A: Retinal tears, traction, accumulated fluid in subretinal space.
S: Elevation of retina from pigment epithelium, anterior pigmented cells, vitreous hemorrhage, tears in retina.
Flashes of light, floaters, black curtain/shadow moving across vision, visual loss.
D: B scan
T: Surgical repair
Optic neuritis
A: Inflammation of optic nerve, most common cause is demyelination.
S: Reduced visual acuity, reduced colour vision, field loss, retrobulbar pain.
D: Consider MRI, LP.
T: IV steroids.
Cataract
A: Opacity of lens from age, sunlight, alcohol, dehydration, corticosteroid use, diabetes.
S: Opacity of lens, reduced vision, glares.
D: -
T: Surgical (phacoemulsification and intraocular lens insertion)
Chronic open-angle glaucome
A: Optic neuropathy, visual field loss, raised ICP, trauma, uveitis, congenital, idioptathic.
S: Usually asymptomatic. Disc cupping, raised IOP, visual field defect, tunnel vision occurs late.
D: Visual field test.
T: Topical drops (eg prostagladin agonists, beta-blockers).
CMV retinitis
A: Infection (cytomegalovirus) associated with HIV/immmunosupression
S: Retinal haemorrhage and whitish areas, floaters, visual reduction.
D: CD4 count,
.
T: HAART, antivirals (eg gangliclovir)
Papilloedema
A: Optic disc swelling due to raised to ICP, can be from intracranial mass, or idiopathic intracranial HTN.
S: Swollen optic discs/blurred/elevated disc margins.
Reduced visual acuity, field defects, headache, nausea, vomiting.
D : -
T: Depends on cause. Weight loss is recommended for idiopathic intracranial HTN, masses may need surgery.
Stye (external hordeolum)
A: Staphylococcal infection
S: Eyelid lump, tender
D: -
T: Eyelid epilation, warm compress, antibiotics
Entropion/Extropion
A: Inversion/Eversion of eyelid
T: Botulinum toxin or surgery
Keratoconjunctivitis sicca (dry eye)
A: Tear film dysfunction: deficient tear production
S: Irritation, redness, compensatory watering
D: Schirmer test shows reduced wetting
T: Artificial tears, lubricating ointment
Orbital/Preseptal cellulitis
A: Streptococcus pneumoniae, staph aureus, strep pyogenes, haemophilus influenzae
S: Orbital: fever, pain, lid swelling/erythema, proptosis, restricted eye movement, diplopia and optic nerve dysfunction.
Preseptal: Same as above, but no proptosis, no restricted eye movements, no optic nerve dysfunction.
D: CT if suspected orbital/sinus disease
T: If orbital, start IV antibiotics - may need surgical drainage.
If septal and systemically unwell, oral antibiotics.
Antibiotics can be penicillins or cephalosporins - vancomycin if resistant
Herpes zoster opthalmicus (eye shingles)
A: Varicella zoster virus reactivation
S: Rash and neuralgia involving opthalmic branch of trigeminal nerve. Hutchinson’s sign (skin lesions at the tip or side of the nose)
D: -
T: Systemic antivirals (aciclovir)
